The Value of Coding Knowledge

By Michelle Del Monico

As health care providers are tasked with more administrative duties such as documentation, coding, and billing, the goal to minimize health care costs will continue to be extremely challenging. In my role, I work with physicians on these challenges daily to ensure not only do the physicians get paid accurately but patients understand their benefits when they see our physicians.  Currently, I am the revenue cycle manager for the Department of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center in Boston, MA.  As a seasoned health care professional, I have 20+ years of experience in medical and surgical coding, revenue cycle operations, and billing compliance. In addition, I continue to provide independent consulting services to private practices and health care organizations.

Recently, I was waiting to be seen for a new patient appointment and had planned for the visit to take one hour. Unbeknownst to me, the majority of my visit was going to be spent on a patient down the hall that needed immediate care. After forty minutes, a physician came in to see me and initiated review of history and exam; the total time he spent with me was approximately 15 minutes. It was at this moment that I understood how a physician can suddenly be taken away from the regular flow of the clinic; it can take providers away from some key medical decision making factors and tasks such as completing an exam, revising a clinical note, or selecting appropriate codes for billing.

The following month, I received a bill and took notice of the CPT codes that were submitted. I instantly realized the level of the Evaluation and Management (E/M) code could not be accurate based on the time spent or the exam performed.  I immediately requested my medical note from the visit. As a medical coding specialist, I am trained to review and abstract coding from medical documentation.  After my visit, I felt very fortunate to have these skills given what level of coding I saw on my bill. Upon review, the exam portion contained elements from the physician’s general visit template and, to my knowledge, more than half of the exam documented was never performed.  All in all, the procedure (CPT) billed was inaccurate, and I requested that the provider review the note and amend as necessary to correct the coding.

This unique opportunity and yet invaluable experience provides a teaching moment regarding the pros and cons of templates and the cut and paste issues that directly contribute to the inaccuracies of medical documentation and billing. Moreover, my case is one out of many that may fall through the cracks, which demonstrates how this may affect the total patient experience and impact revenue flow for the practice as well as ensuring the patient is paying the correct amount.

Empowering patients to become proactive with their medical bills by requesting a detailed invoice from the billing vendor or reaching out to their health care providers to further understand services performed can trigger communication pathways. This type of patient feedback can help design new ways for physician practices to ensure accuracy and can provide further insight to health care providers on how to balance the delivery of high quality care while simultaneously controlling costs.

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Michelle Del Monico is a Certified Professional Coder and Senior Manager of Revenue Cycle in the Department of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center in Boston, Ma. She also provides independent consulting services to private practices and health care organizations.